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FIG 13:

Severe cellulitis of the axilla and forelimb of a dog with ill-defined swelling, erythema, purpura and necrosis

Necrotising fasciitis is a rare but severe form of cellulitis associated with dissemination of bacterial toxins (Naidoo and others 2005). There is rapid progression with severe cellulitis, swelling, necrosis, infection of deeper tissues and septicaemia, which is often fatal. Affected dogs are usually dull to depressed and pyrexic.

The clinical signs are often highly suggestive of pyoderma, but the diagnosis must be confirmed using cytology and, where necessary, bacterial culture and antibiotic sensitivity testing. Antimicrobials should not be speculatively used on the basis of the clinical signs only ( Fifi Venezia Embroidered Canvas Mules w/ Tags tumblr online for sale the cheapest cheapest price cheap price 2015 new for sale outlet fast delivery mI9f7lqJVR
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, Nuttall and others 2008, Guardabassi and Fondati 2009 ).

Cytology is a simple, quick and minimally invasive technique, which can be performed on fully conscious animals with minimum risk and no lasting harm.

There are a number of different methods, some of which are better suited to certain conditions and situations than others (Mendelsohn and others 2006, Mueller 2009 ). Techniques include:

Adhesive tape-strips.

Direct impression smears.

Indirect impression smears.

Needle cores and fine needle aspirates.

Adhesive tape-strip cytology

Adhesive tape can be used to remove the outer layers of the stratum corneum and adherent microorganisms. Adhesive tape-strip cytology is an excellent method to sample dry, greasy, scaling or eroded lesions. It is especially useful for irregular surfaces or restricted sites such as the interdigital skin. Tape-strips are less useful with moist lesions, such as pustules, exudates, erosions or ulcers, as material may fail to adhere to the tape.

Direct and indirect impression smears

Impression smears are especially useful for moist or seborrhoeic lesions that will not stick to adhesive tape. Direct impression smears are made by applying the microscope slide directly to the lesion, such as an erosion, underside of a crust or ruptured pustule. It may be necessary to gently debride the surface to reveal representative cells. Indirect impression smears are appropriate when the slide cannot be apposed to the skin and adhesive tape-strips are unsuitable. Material can be collected and transferred to microscope slides using cotton buds, spatulas, scalpel blades and so on.

Needle cores

Needle cores (ie, needle insertion, and rotation and/or reposition) are useful for cutaneous masses and enlarged lymph nodes. It can be difficult to obtain material by simple needle cores from very firm or fluid-filled lesions. These may need aspirating using a syringe, which can harvest more material and cells, but also causes more trauma, damaged cells and haemorrhage. This may make it difficult to interpret the samples.

Staining of cytology samples

Modified Wright-Giemsa stains such as Rapi-Diff or Diff-Quik are suitable for practice use. These stains are quick and easy to use, and can be used to reliably identify inflammatory cells and microorganisms. Heat fixation prior to staining is not necessary (Toma and others 2006). Some adhesive tapes, however, dissolve or turn opaque in the fixative. Adhesive tapes should be used with the eosinophilic and basophilic stains only, although some brands will still be affected by the stains. An alternative method involves placing a drop of the basophilic stain only on the preparation and then placing the adhesive tape or cover-slip on top. This results in very intense staining of microorganisms, but gives a monochromatic stain where it may be more difficult to identify inflammatory cells (Toma and others 2006). Other stains such as Gram and Ziehl-Neelsen can be used to more precisely identify bacteria, but are more time consuming and difficult, and are rarely performed in practice laboratories.

Neutrophils predominate in most cases of pyoderma (Mendelsohn and others 2006). Degenerate or toxic neutrophils are a good indication of infection (Fig Lynda Bow Espadrille Mule cheap sale very cheap excellent online buy cheap price for nice cheap price cvstd
). They appear swollen and have indistinct nuclei with an open and disrupted chromatin pattern (karyorrhexis). Nuclear streaming is common, as the cells are fragile and vulnerable to trauma. Non-degenerate neutrophils appear to be smaller, with dark, shrunken nuclei (pycnosis), and nuclear streaming is less common. They are more usually associated with sterile inflammation, but there is no exact differentiation between degenerate and non-degenerate neutrophils—both may be seen in the same smear, and their presence or absence should not be relied on to exclude the possibility of an infection.

(the court of criminal appeals may rely upon continuing eligibility for limited military benefits as a factor in assessing the impact of post-trial delay, but it must do so in a manner that focuses on the circumstances of the particular case; because post-trial processing entails continuing eligibility for benefits in all cases, it is not appropriate to rely on the availability of benefits as a basis for denying relief in a particular case without relating it to the circumstances of the accused in that case).

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, 61 M.J. 103 (in the course of addressing the issue of timely appellate review and finding that appellant had failed to show that the delay was unreasonable, the court below commented that appellant did not raise the issue before the convening authority acted; however, the timeliness issue did not involve the period preceding the convening authority’s action; rather, the issue involved the period after the convening authority acted -- the unexplained and unusual period of more than one year and five months to accomplish the routine, nondiscretionary, ministerial task of transmitting the record from the convening authority to the appellate review activity; because the court below did not focus on the relevant period of delay, we decline to rely on the court’s conclusion that relief would not be warranted for unreasonable and unexplained delay and remand it to the lower court for further review of the sentence under Toohey , Diaz , Tardif , and Jones ).

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, 61 M.J. 80 (where appellant’s trial lasted fifty-five minutes and resulted in a thirty-seven-page record of trial, and 363 days elapsed before the record was docketed with the lower appellate court, this unexplained post-trial delay was facially unreasonable).

(an appellant’s constitutional due process right to a speedy post-trial review is a right separate and distinct from the “sentence appropriateness” review under Article 66, UCMJ; determining whether post-trial delay violates an appellant’s due process rights turns on four factors: (1) the length of the delay; (2) the reasons for the delay, (3) the appellant’s assertion of the right to a timely appeal; and (4) prejudice to the appellant).

(the “length of delay” factor serves two functions: (1) the length of delay is to some extent a triggering mechanism, and unless there is a period of delay that appears, on its face, to be unreasonable under the circumstances, there is no necessity for inquiry into the other factors that go into the balance; (2) if the constitutional inquiry has been triggered, the length of delay is itself balanced with the other factors and may, in extreme circumstances, give rise to a strong presumption of evidentiary prejudice affecting the fourth factor).

(in this case, the post-trial delay was facially unreasonable; the Government offered no justification for the appellate delay and the record failed to disclose any; the record reflected that appellant complained about the delay in post-trial processing; and the excessive post-trial delay prejudiced appellant by interfering with his post-military employment opportunities).

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